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Subject: Friend, what goes through your mind at the OSCE room and patients' interview doors?

What goes through your mind in the moment before you walk into the room to see your next patient? A flurry of thoughts about all the patients you've already seen and the mountain of admin tasks you need to finish later today?

An Interesting Article Shared By OSCEhome

Six mindfulness techniques for physicians

Published on medicalnewstoday.com on 21 June 2017 By Flavia Munn

But what if you paused - for just 3 seconds - as you touch the door handle, took a breath to be present, and let go of all that has gone before and all that is ahead of you?

Everyone has time to do this, Ronald M. Epstein, M.D. - a professor of medicine at the University of Rochester in New York, a family and palliative care physician, and author of Attending: Medicine, Mindfulness, and Humanity - told Medical News Today.

He uses the "doorknob" example in the many international lectures he gives each year on mindfulness, but readily admits that he is as skeptical as the next doctor.

"I don't like this touchy feely stuff. I am not a new age kind of person. I am very skeptical," Dr. Epstein explained. "Some people say 'I can't stop my thoughts.' Well, it's not about stopping your thoughts - it's about paying attention to them," he noted.

For Dr. Epstein, mindfulness is a powerful tool for medical professionals in dealing with personal stress, being more compassionate, and reducing clinical errors.

"Anyone whose work involves immense human suffering needs to be aware of their inner life. The nature of the work that physicians do makes [them] more vulnerable to negative emotions or making errors," he added.

With roots in yoga, mindfulness was brought to the West by University of Massachusetts emeritus professor of medicine, Jon Kabat-Zinn, M.D.

Some of the medical advocates of mindfulness came to it through personal experience and have gone on to teach it to their fellow doctors.

Dr. Gwen Adshead, a forensic psychiatrist and psychotherapist who has worked with distressed doctors in both the United States and the United Kingdom, is one of the founders of Mindfulness for Doctors.

Dr. Adshead discovered mindfulness in 2008 while taking antidepressants for postnatal depression. "I have not had a relapse since," she told MNT. "It significantly improved my mood regulation. It gives me a much better sense of when thoughts and feelings come to my mind. I stop ruminating."

But she, like most of its proponents, says that mindfulness is not a panacea, and, for those who are unwell, it needs to be part of a wider treatment plan.

Six mindfulness techniques to try today

Are you looking for a way to focus and distress? Try these six mindfulness techniques today and see how other physicians have benefited from incorporating mindfulness into their daily lives.

1. Pause and breatheThis is similar to Dr. Epstein's doorknob example and combines a number of other approaches. Pause, breathe, and notice, for example, your feet on the ground.

Mindfulness Training Institute Australasia co-director Maura Kenny, who runs 6-week mindfulness courses for doctors, said, "A surgeon who took the course told me that at tricky moments during operations, this has helped him stay calm and clear so he is better able to respond precisely as needed to the problem at hand."

2. Mindful meditationUsing this meditation on the natural breath, be aware of the touch of the breath and the different sensations as you breathe. Exercise compassion by not being hard on yourself when the mind wanders, and gently return your attention to the breath.

This practice is generally done seated - on the floor or sitting in a chair - but can be done "on the move." Mark Williams, retired director of the Oxford Mindfulness Centre in the U.K., suggests that you can do this for as little as 1 minute while sitting on a chair, all the while being aware of the spine, as well as the feet on the floor.

3. Awareness of feelings and thoughtsWatch your thoughts come and go. You can also name individual thoughts - for example, "this is anger." Some practices involve asking "How do I feel?" and naming the emotion.

In his bestselling book Mindfulness: Finding Peace in a Frantic World, Williams and co-author Danny Penman suggest viewing thoughts as clouds moving across a sky - with some dark and some light, some big and some small. They also advise noting the "emotional charge" that the thoughts bring, and letting them be.

4. Find your feetThis is as simple as it sounds: when seated or standing, become aware of where your feet are, their position on the floor, the balance of weight between the two feet, and any sensations in them.

This technique is also used in public speaking training.

5. Make ordinary tasks extraordinaryMake tasks less of a routine by experiencing them as if for the first time, and with the inquisitive nature of a child. Dr. Epstein asks participants at his workshops to eat their lunch using their non-dominant hand.

Similarly, this can be done when brushing your teeth or washing the dishes. The aim is to notice the activity itself.

The same can be done when, for instance, walking in nature - take in the surroundings, sound, vision, and feel. Take yourself off "autopilot" when on a usual route or routine.

6. Body scanLying down, bring awareness to different parts of the body, notice the body's position in space, and take note of any sensations - both pleasant and unpleasant - while acting as a non-judgmental witness to the experience.

The aim is to cultivate awareness and be present with whatever is happening. However, people also use it for sleep issues. Dr. Adshead said that she started with this practice, brought to prominence by Dr. Kabat-Zinn, and turns to it if she's having difficulty sleeping.

Mindfulness on the goAnne Speckens, a professor of psychiatry at Radboud University Medical Centre in the Netherlands, told MNT that medical students and doctors often have difficulty maintaining formal practices. She advises that they practice on the go.

To achieve this, she recommended, "Taking breaks more regularly, going for a short walk rather than joining busy coffee rooms, paying attention to drinking your cup of coffee rather than gulping it down, [and] taking a breathing space in between seeing patients at your outpatient clinic."

Others use their daily commute or exercise regime to practice awareness of senses and surroundings.

There are many mindfulness practices, and physicians can use inventive ways to integrate these into their daily lives. Try destressing with a mindful cup of tea - noticing the look, smell, taste, and sensation - at the end of your next shift handover.

Alys Cole-King, a consultant liaison psychiatrist working in Wales, U.K., runs an organization called Connecting with People, which teaches compassion at work programs, including mindfulness, to healthcare professionals.

"I think it's very helpful for me in a hospital clinic situation where there may be a large number of patients to see. Using mindfulness techniques during a very short appointment allows you to focus on that patient, giving them your undivided attention," she told MNT.

If you feel that you just don't have time for it, remember this: Dr. Adshead likens it to going to the gym, saying, "You know you should go to the gym but you have to make time to go. When you start going on a regular basis you often feel stiff - it's the same with mindfulness."

And you could start by pausing - for just those 3 seconds - when you touch the door handle on your way to see your next patient.

The OSCEhome Systematic Approach For The OSCEs and Clinical Patient Interview Did Cover These Mindfulness Techniques Since Its First Edition In 2005 In The Ten Actions You Have To Do At Each Exam Room Door!

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